| NPI | 1376913244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: ASW109882) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW109882) |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2015-10-04 |
| Last Update Date | 2023-07-06 |